‘Reasonable and necessary’ care: the challenge of operationalising the NDIS policy principle in allocating disability care in Australia

Abstract

Disability reform in Australia centres on a National Disability Insurance Scheme (NDIS), which aims to provide lifelong, individualised support based on the principle of ‘reasonable and necessary’ care. As a universal rights‐based scheme it represents a historical shift in allocation principles in Australia's disability policy. Nonetheless, attention will be on determining who receives what care given the diversity of personal and family contexts. The aim of this paper is to discuss the operational complexities of a principle of reasonable and necessary care with reference to the findings of a three‐year study on the experiences and perspectives of disability care of 25 adults with acquired disability, their 22 nominated family members and 18 service providers. Evidence from this study suggests enacting the principle of reasonable and necessary care and support will be problematic, in particular as it relates to personalising the level and scope of services, balancing formal and informal care, and principles of equity. The paper contributes to the literature about allocation principles in social policy and the challenges of implementation. Further, it provides an empirically informed discussion of some of the specific policy implementation challenges concerning the NDIS.

Providing physical health care for people accessing mental health services: Clinicians’ perceptions of their role

“…A NSW Health Department state policy directive and guidelines were developed in 2009 to address the physical health of people who access mental health services and updated in 2017 (NSW Ministry of Health, 2017). The introduction of the National Disability Insurance Scheme (NDIS) in Australia has some capacity to provide 'reasonable and necessary' interventions for people with a range of disabilities (Foster et al 2016), but realizing the full potential of the NDIS for people with mental illness may be dependent on mental health clinicians' knowledge of NDIS services availability and their practices in the promotion of, and referral to these services. The introduction of the National Disability Insurance Scheme (NDIS) in Australia has some capacity to provide 'reasonable and necessary' interventions for people with a range of disabilities (Foster et al 2016), but realizing the full potential of the NDIS for people with mental illness may be dependent on mental health clinicians' knowledge of NDIS services availability and their practices in the promotion of, and referral to these services.…”

“…Despite the introduction of these and other guidelines, addressing the physical health of people accessing mental health services remains a significant evidence-practice gap (Bartlem et al 2014;Ward et al 2017). The introduction of the National Disability Insurance Scheme (NDIS) in Australia has some capacity to provide 'reasonable and necessary' interventions for people with a range of disabilities (Foster et al 2016), but realizing the full potential of the NDIS for people with mental illness may be dependent on mental health clinicians' knowledge of NDIS services availability and their practices in the promotion of, and referral to these services.…”

From Criminalisation to Individual Choice: Policy Responses to Changing Constructions of Intellectual Disability in Western Australia

“…In 2008, the proposal for a fully funded National Disability Insurance Scheme (NDIS) for people with disability was accepted by the Australian government (Reddihough et al 2016). The scheme commenced in 2013 (2014 in WA), signifying a major change in the distribution of disability funding from 'block funding' to service providers, to individualised funding offering choice and control to people with disability (Foster et al 2016), aligning with neoliberal principles of the free market through a market-driven approach to disability care and services (Carey et al 2017). The NDIS also signified a change in the neoliberal use of the term ' consumer' or ' customer' to 'participant' under the NDIS.…”

“…The national scheme was introduced following recommendations from the Productivity Commission enquiry to explore funding for disability services that refocused disability support to a national level. Its purpose is to enable economic sustainability of support arrangements to allow people with disability to actively participate in society and have care and support over their lifetime (Foster et al 2016;Purcal, Fisher & Meltzer 2016). The competitive 'marketplace' of disability services emerged as a result of globalisation and neoliberal ideology in the late-20th century and has re-emerged in the legislation that drives the NDIS.…”

“…The competitive 'marketplace' of disability services emerged as a result of globalisation and neoliberal ideology in the late-20th century and has re-emerged in the legislation that drives the NDIS. Based on 'user led' choice and control, it is expected that the disability care market will see disability services emerge from 'for-profit', non-government providers under the NDIS (Foster et al 2016). Conceptually, it could lead to a reinvented welfare system that is more responsive to the aspirations of service users.…”